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Dyslipidemia in Adults with Type 2 Diabetes in a Rural Community in Ganadougou, Mali: A Cross-Sectional Study. 马里加纳杜古农村社区 2 型糖尿病成人的血脂异常:一项横断面研究
Pub Date : 2024-05-01 Epub Date: 2024-05-31 DOI: 10.4236/jdm.2024.142012
Abdoulaye Diawara, Djibril Mamadou Coulibaly, Drissa Kone, Mama A Traore, Drissa Konaté, Dicko S Bazi, Oumar Kassogue, Djeneba Sylla, Fatoumata Gniné Fofana, Oudou Diabaté, Mariam Traore, Ibrahim Antoine Nieantao, Kaly Keїta, Mamadou Diarra, Olivia Smith, Jian Li, Cheickna Cisse, Talib Yusuf Abbas, Crystal Zheng, Segun Fatumo, Kassim Traore, Mamadou Wele, Mahamadou Diakité, Seydou O Doumbia, Jeffrey G Shaffer

Dyslipidemia is a disorder where abnormally lipid concentrations circulate in the bloodstream. The disorder is common in type 2 diabetics (T2D) and is linked with T2D comorbidities, particularly cardiovascular disease. Dyslipidemia in T2D is typically characterized by elevated plasma triglyceride and low high-density lipoprotein cholesterol (HDL-C) levels. There is a significant gap in the literature regarding dyslipidemia in rural parts of Africa, where lipid profiles may not be captured through routine surveillance. This study aimed to characterize the prevalence and demo-graphic profile of dyslipidemia in T2D in the rural community of Ganadougou, Mali. We performed a cross-sectional study of 104 subjects with T2D in Ganadougou between November 2021 and March 2022. Demographic and lipid profiles were collected through cross-sectional surveys and serological analyses. The overall prevalence of dyslipidemia in T2D patients was 87.5% (91/104), which did not differ by sex (P = .368). High low-density lipoprotein cholesterol (LDL-C) was the most common lipid abnormality (78.9%, [82/104]). Dyslipidemia was associated with age and hypertension status (P = .013 and.036, respectively). High total and high LDL-C parameters were significantly associated with hypertension (P = .029 and .006, respectively). In low-resource settings such as rural Mali, there is a critical need to improve infrastructure for routine dyslipidemia screening to guide its prevention and intervention approaches. The high rates of dyslipidemia observed in Gandadougou, consistent with concomitant increases in cardiovascular diseases in Africa suggest that lipid profile assessments should be incorporated into routine medical care for T2D patients in African rural settings.

血脂异常是指血液中循环的脂质浓度异常。这种疾病常见于 2 型糖尿病(T2D)患者,与 T2D 合并症,尤其是心血管疾病有关。2 型糖尿病患者血脂异常的典型特征是血浆甘油三酯水平升高和高密度脂蛋白胆固醇(HDL-C)水平降低。有关非洲农村地区血脂异常的文献存在很大空白,因为这些地区的血脂状况可能无法通过常规监测获得。本研究旨在描述马里加纳杜古农村社区 T2D 患者血脂异常的患病率和人口统计学特征。我们在 2021 年 11 月至 2022 年 3 月期间对加纳杜古的 104 名终末期糖尿病患者进行了横断面研究。通过横断面调查和血清学分析收集了人口和血脂概况。血脂异常在 T2D 患者中的总患病率为 87.5%(91/104),无性别差异(P = .368)。高低密度脂蛋白胆固醇(LDL-C)是最常见的血脂异常(78.9%,[82/104])。血脂异常与年龄和高血压状态有关(P = 0.013 和 0.036)。高总胆固醇和高低密度脂蛋白胆固醇参数与高血压显著相关(P = .029 和 .006)。在马里农村等低资源环境中,迫切需要改善常规血脂异常筛查的基础设施,以指导其预防和干预方法。在甘达杜古观察到的高血脂异常率与非洲心血管疾病的同步增长相一致,这表明血脂状况评估应纳入非洲农村地区 T2D 患者的常规医疗护理中。
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引用次数: 0
Nobel prize winners in metabolism history and diabetology 代谢史和糖尿病学的诺贝尔奖得主
Pub Date : 2023-08-19 DOI: 10.14341/dm13032
© Я.А. Эль-Тарави, Д.К. Эрикенова, А.С. Одарченко, С.Т. Магеррамова, М.В. Шестакова, Yasmin A. El-Taravi, D. K. Erikenova, Arina S. Odarchenko, S. T. Magerramova, Marina V. Shestakova
The 20th century was the time of large-scale discoveries and their widespread recognition. Metabolism studies and their role in living organisms deserve special attention. The chemical, physical, and biological metabolic reactions are the basis of life. Known details of these reactions are the key to understanding energy processes occurring in living organisms. Many scientists have devoted their scientific careers to the study different metabolic processes, and their most fundamental and landmark discoveries have been awarded with the Nobel Prize in Physiology or Medicine. This award, the most iconic achievement for any scientist, has been given since the beginning of the 20th century for the most outstanding discoveries for all mankind. This review of the literature highlights the most important metabolic discoveries of the 20th century that have played a key role in understanding how all living organisms work: the catalytic conversion of glycogen (Cori cycle), the tricarboxylic acid cycle (Krebs cycle), and cholesterol and the role of adenohypophysis hormones in glucose metabolism.
20世纪是大规模发现和广泛认可的时代。代谢研究及其在生物体中的作用值得特别关注。化学、物理和生物代谢反应是生命的基础。这些反应的已知细节是理解生物体中发生的能量过程的关键。许多科学家致力于研究不同的代谢过程,他们最基本和具有里程碑意义的发现被授予诺贝尔生理学或医学奖。自20世纪初以来,这个对所有科学家来说最具标志性成就的奖项一直颁发给对全人类最杰出的发现。这篇文献综述强调了20世纪最重要的代谢发现,这些发现在理解所有生物体如何工作方面发挥了关键作用:糖原的催化转化(Cori循环)、三羧酸循环(Krebs循环)、胆固醇和腺垂体激素在葡萄糖代谢中的作用。
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引用次数: 0
Early intensification of therapy for type 2 diabetes mellitus and achievement of the target level of glycohemoglobin HbA1c are necessary factors to reduce the risk of micro- and macrovascular complications 2型糖尿病早期加强治疗,达到糖化血红蛋白目标水平是降低微血管和大血管并发症发生风险的必要因素
Pub Date : 2023-08-17 DOI: 10.14341/dm13079
© М.Ш. Шамхалова, О Ю Сухарева, ©. Minara, S. Shamkhalova, O. Y. Sukhareva
Control of type 2 diabetes mellitus (T2DM) requires multifactorial behavioral and pharmacological treatment to prevent the development or slow the progression of complications. The main characteristics of T2DM — hyperglycemia and insulin resistance, combined with oxidative stress, low-level inflammation, epigenetic changes, genetic predisposition, activation of the renin-angiotensin-aldosterone system, causing endothelial dysfunction, are responsible for the metabolic environment that increases vascular risk in patients. Almost all patients with type 2 diabetes are at high and very high cardiovascular risk. The largest studies of the late XX-early XXI centuries. demonstrated a significant reduction in complications with intensive care early in the course of the disease and a «legacy effect» with the long-term historical value of HbA1c control during their observational follow-ups. The decrease in HbA1c may also play a role in mediating the positive effect on cardiovascular risk observed with the use of new hypoglycemic agents. The desire for glycemic control and the desire for organ-specific protection are not mutually exclusive, but complementary. Reassessing individual glycemic goals and achieving them at regular intervals with early intensification of therapy is key to overcoming clinical inertia.
2型糖尿病(T2DM)的控制需要多因素的行为和药物治疗,以防止并发症的发生或减缓其进展。T2DM的主要特征-高血糖和胰岛素抵抗,加上氧化应激、低水平炎症、表观遗传改变、遗传易感性、肾素-血管紧张素-醛固酮系统的激活,导致内皮功能障碍,是导致患者血管风险增加的代谢环境的原因。几乎所有2型糖尿病患者都有很高或非常高的心血管风险。20世纪末到21世纪初最大规模的研究。在病程早期的重症监护中,并发症显著减少,并且在观察随访期间,HbA1c控制具有长期历史价值的“遗留效应”。HbA1c的降低也可能在使用新型降糖药观察到的心血管风险的积极作用中起中介作用。对血糖控制的渴望和对器官特异性保护的渴望不是相互排斥的,而是互补的。重新评估个人血糖目标并在早期加强治疗的情况下定期达到目标是克服临床惰性的关键。
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引用次数: 0
T-lymphocytes FoxP3+ and their interconnection with the severity of coronary atherosclerosis in patients with coronary artery disease and diabetes mellitus type 2: a pilot study t淋巴细胞FoxP3+及其与冠心病合并2型糖尿病患者冠状动脉粥样硬化严重程度的相关性:一项初步研究
Pub Date : 2023-07-14 DOI: 10.14341/dm12980
I. Kologrivova, O. Koshelskaya, T. Suslova, O. Kharitonova, O. Trubacheva, E. Kravchenko, A. Dmitriukov
BACKGROUND: One of the common pathogenic links of diabetes mellitus type 2 (T2DM) and coronary artery disease (CAD) is chronic low-grade inflammation, restricted by FoxP3+ T-regulatory lymphocytes.AIM: To investigate the numbers of FoxP3+CD25hi and FoxP3+CD25lo T-lymphocytes, the subcellular localization of FoxP3 in them, and the production of the main cytokines in relation to clinical and metabolic parameters in patients with association of CAD and T2DM.MATERIALS AND METHODS: An observational single-center single-stage comparative study was conducted. The severity of atherosclerosis was assessed by calculating the Gensini Score index after coronary angiography. Absolute numbers and frequencies of CD4+CD25hiFoxP3+ and CD4+CD25loFoxP3+ T-lymphocytes were assessed in peripheral blood by flow cytometry. Imaging flow cytometry was used to determine the degree of FoxP3 translocation to the cell’s nucleus. Concentration of cytokines in blood serum and supernatants of mononuclear leukocytes’ cultures was determined by the multiplex analysis.RESULTS: We recruited 57 patients with chronic CAD. Of these, T2DM was diagnosed in 22 patients. In patients with CAD and T2DM, the absolute numbers and frequencies of FoxP3+CD25lo cells were increased compared to patients with CAD without diabetes (1.15 (0.98; 1.73) vs. 0.96 (0.60; 1.15)% (р=0.046); 1.48 (1.05; 1.97) vs. 1.07 (0.71; 1.42) x107/L (р=0.025)). Patients with T2DM also had a higher level of translocation of FoxP3 to the nucleus of FoxP3+CD25lo cells (92.0 (86.4; 95.0) vs. 88.7 (80.0; 91.4)%, р=0.040) and increased concentration of the chemokine CCL22 both in blood serum (912 (828; 1061) vs. 669 (585; 738) pg/mL, р=0.022) and supernatants of LPS-stimulated mononuclear leukocyte cultures (1189 (851; 1310) vs. 539 (437; 949) pg/mL, р=0.038), which correlated with the presence of CD4+CD25hiFoxP3+ cells (Rs=0.587; p=0.044) and the triglyceride/glucose index (Rs=0.587; p=0.044). The identified changes were most pronounced in patients with moderately elevated values on the Gensini Score (17–45 points).CONCLUSION: We are the first to show association between the numbers of FoxP3+CD25lo-lymphocytes in peripheral blood and an increase in the nuclear translocation of FoxP3 in them with the severity of atherosclerosis in patients with association of CAD and T2DM. These data justify the necessity of the further investigation of the diagnostic significance of FoxP3+CD25lo-cells as biomarkers of tissue inflammation.
背景:慢性低度炎症是2型糖尿病(T2DM)和冠心病(CAD)的常见致病环节之一,受FoxP3+ t调节性淋巴细胞的限制。目的:探讨冠心病合并T2DM患者FoxP3+CD25hi、FoxP3+CD25lo t淋巴细胞数量、FoxP3在其中的亚细胞定位及主要细胞因子的产生与临床及代谢参数的关系。材料与方法:采用观察性单中心单阶段比较研究。冠状动脉造影后通过计算Gensini评分指数评估动脉粥样硬化的严重程度。采用流式细胞术检测外周血CD4+CD25hiFoxP3+和CD4+CD25loFoxP3+ t淋巴细胞的绝对数量和频率。成像流式细胞术检测FoxP3向细胞核的易位程度。用多重分析法测定单核白细胞培养血清和上清液中细胞因子的浓度。结果:我们招募了57例慢性CAD患者。其中,22例患者被诊断为T2DM。在冠心病合并T2DM患者中,FoxP3+CD25lo细胞的绝对数量和频率比无糖尿病的冠心病患者增加(1.15 (0.98;1.73) vs. 0.96 (0.60;1.15) %(р= 0.046);1.48 (1.05;1.97) vs. 1.07 (0.71;1.42) x107/L (χ =0.025))。T2DM患者FoxP3易位到FoxP3+CD25lo细胞核的水平也更高(92.0 (86.4;95.0) vs. 88.7 (80.0;血清中趋化因子CCL22浓度升高(912 (828;1061 vs. 669 (585;738) pg/mL, r =0.022)和lps刺激的单核白细胞培养上清(1189 (851;1310) vs. 539 (437;949) pg/mL, r =0.038),与CD4+CD25hiFoxP3+细胞的存在相关(Rs=0.587;p=0.044),甘油三酯/葡萄糖指数(Rs=0.587;p = 0.044)。这些变化在Gensini评分(17-45分)中度升高的患者中最为明显。结论:我们首次发现冠心病合并T2DM患者外周血FoxP3+ cd25o淋巴细胞数量及FoxP3核易位增加与动脉粥样硬化严重程度相关。这些数据证明有必要进一步研究FoxP3+ cd25lo细胞作为组织炎症生物标志物的诊断意义。
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引用次数: 0
Modern understanding of latent autoimmune diabetes in adults 成人潜伏性自身免疫性糖尿病的现代认识
Pub Date : 2023-07-14 DOI: 10.14341/dm12994
I. I. Golodnikov, N. V. Rusyaeva, T. Nikonova, I. Kononenko, M. Shestakova
Latent autoimmune diabetes in adults (LADA) according to various sources is from 4 to 12% of all cases of type 2 diabetes mellitus (T2DM). Its uniqueness lies in the simultaneous combination of autoantibodies to β-cells (characteristic of T1DM) and the possibility of treatment with oral hypoglycemic drugs (characteristic of T2DM) for at least 6 months. This is based on the pathogenesis common for T1DM and T2DM — the presence of an autoimmune reaction with the simultaneous involvement of adaptive and innate immunity, as well as, to a lesser extent, insulin resistance and a number of components of the metabolic syndrome. LADA has more in common with T1DM — the same stages in the development of the disease, from genetic predisposition to the undoubted development of insulin dependence, the difference lies in the duration of each of the periods and the age of manifestation. LADA is characterized by an older age of manifestation of 30–35 years and a slower rate of destruction of β-cells. This article presents data on the diagnosis, progress of LADA, its similarities and differences with other types of DM, and immunological features. The article also analyzes the modern approach to the treatment of patients with LADA and promising methods of treatment. The search for information was processing in published sources attached to the search engines PubMed, Google Scholar, Scopus, Web of Science, eLibrary.ru over the past 10 years. The following medical subject headings were used: latent autoimmune diabetes in adults, diabetes mellitus type 1 and 2, immunology, pancreas, genetic, treatment in various combinations using OR and AND logical operators.
根据各种来源,成人潜伏性自身免疫性糖尿病(LADA)占所有2型糖尿病(T2DM)病例的4%至12%。其独特之处在于同时联合β细胞自身抗体(T1DM的特征)和口服降糖药(T2DM的特征)治疗至少6个月的可能性。这是基于T1DM和T2DM的共同发病机制——自身免疫反应的存在,同时涉及适应性免疫和先天免疫,以及胰岛素抵抗和代谢综合征的一些组成部分(在较小程度上)。LADA与T1DM有更多的共同之处——在疾病发展的相同阶段,从遗传易感性到毋庸置疑的胰岛素依赖,不同之处在于每个阶段的持续时间和表现的年龄。LADA的特点是年龄较大,表现为30-35岁,β细胞的破坏速度较慢。本文就LADA的诊断、进展、与其他类型糖尿病的异同及免疫学特征作一综述。文章还分析了LADA患者的现代治疗方法和有前途的治疗方法。在过去的10年里,对信息的搜索是在PubMed、Google Scholar、Scopus、Web of Science、elibrlibrary .ru等搜索引擎上发布的资源中进行的。使用以下医学主题标题:成人潜伏性自身免疫性糖尿病,1型和2型糖尿病,免疫学,胰腺,遗传学,使用OR和and逻辑运算符的各种组合治疗。
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引用次数: 0
Detectıon of vısual-audıtory reactıon rates ın ındıvıduals wıth type 2 dıabetes mellıtus
Pub Date : 2023-07-14 DOI: 10.14341/dm12997
M. Bilaloglu, A. Ergun, F. Altay, Ö. T. İyidir, E. Kızıltan
AIM: The primary purpose of our study was to understand the damage in the peripheral nerves of patients with diabetes and to determine the change in patients’ reaction rates and perceptions by the age groups, duration of diabetes, fasting plasma glucose and HbA1c values, and compare these with those of the healthy individuals.METHODS: This study was carried out at the Baskent University Hospital Endocrinology and Metabolic Diseases Outpatient Clinic. A total of 64 patients diagnosed with type 2 diabetes and 64 healthy controls were included in the study. Finger tapping, visual, and auditory reaction time tests were performed on the subjects, respectively. The subjects’ fasting plasma glucose and HbA1c levels, and the duration of their diabetes were recorded. Analyses were performed using the SPSS version 25. Differences were considered statistically significant when the p-value is <0.05.RESULTS: It was observed that the participants in the control group between the ages of 18-34 showed a faster reaction in all tests (p=0.01), but the difference in reaction rates in both groups decreased as the age increased. There were positive correlations between the duration of type 2 diabetes and the visual and auditory examination results (r= 0.69, p<0.05, r=0.52, p<0.05, respectively). There was also a positive correlation between the HbA1c (%) and the visual (r=0.97, p<0.05) examination results.CONCLUSIONS: As the patients’ HbA1c levels and the time spent with type 2 diabetes increased, their reaction rate and perception skills decreased. Especially in the early stages of the disease, cognitive decline was observed to be rapid. It is thought that early diabetic control is significant.
目的:我们研究的主要目的是了解糖尿病患者周围神经的损伤情况,确定患者的反应率和感知随年龄组、糖尿病病程、空腹血糖和HbA1c值的变化,并与健康人进行比较。方法:本研究在巴斯肯特大学医院内分泌与代谢疾病门诊进行。共有64名诊断为2型糖尿病的患者和64名健康对照者参与了这项研究。分别对受试者进行手指敲击、视觉和听觉反应时间测试。记录受试者的空腹血糖和糖化血红蛋白水平以及糖尿病持续时间。使用SPSS版本25进行分析。当p值<0.05时,认为差异有统计学意义。结果:对照组18 ~ 34岁受试者在各项测试中的反应均较快(p=0.01),但两组反应率差异随年龄的增加而减小。2型糖尿病病程与视、听检查结果呈正相关(r= 0.69, p<0.05, r=0.52, p<0.05)。HbA1c(%)与目视检查结果也呈正相关(r=0.97, p<0.05)。结论:随着患者HbA1c水平和2型糖尿病时间的增加,患者的反应率和感知能力下降。特别是在疾病的早期阶段,认知能力下降被观察到是迅速的。人们认为早期控制糖尿病是很重要的。
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引用次数: 0
The role of individual organization of circadian rhythms in the formation of carbohydrate metabolism disorders 个体组织的昼夜节律在碳水化合物代谢紊乱形成中的作用
Pub Date : 2023-07-14 DOI: 10.14341/dm12909
Yu. V. Nelaeva, O. Rymar, I. Petrov, A. Nelaeva, A. Yuzhakova
BACKGROUND: In medical literature sources, there are data on the relationship of disorders of circadian rhythms (desynchronosis) with the development of type 2 diabetes mellitus (T2DM). Desynchronosis of circadian rhythms of glycemia can be triggered both by external factors (exposure to excessive artificial lighting in the evening, violation of the diet, «sleep-wake»), and internal — from the individual organization of circadian rhythms (chronotype). In this connection, there is an interest in the most detailed study of the influence of individual characteristics of the organization of circadian rhythms on the risk of developing T2DM. AIM: To characterize the individual organization of circadian rhythms in persons without carbohydrate metabolism disorders, with prediabetes and T2DM with obesity and BMI = 30.0–34.9 kg/m2.MATERIALS AND METHODS: Тhe Horn-Ostberg questionnaires were analyzed retrospectively in individuals with visceral obesity without carbohydrate metabolism disorders (n=40), with prediabetes (n=40) and T2DM (n=40). The results of the Horn-Ostberg test were compared with anamnestic anthropometric, laboratory parameters, nutrition diaries, daily rhythms of integral physiological indicators of carbohydrate and energy metabolism.RESULTS: All study participants (n=120) were identical age 56,7 [52,2; 58,6] years, BMI 31.3 [30.7; 33.9] kg/m2, waist circumference (OW) in women 96.54 ± 1.35 cm in men 98.75 ± 2.61 cm Sex distribution: 73% women and 27% men. Persons with morning chronotype made up 24% (29 people), intermediate 63% (75 people) and evening 13% (16 people) . In the groups, the late time for the first breakfast was noted (without carbohydrate metabolism disorders 9:45h, prediabetes 9:31 and T2DM 10:00h), and 20% of the participants missed it (p<0.05). A larger amount of daily energy value was shifted to the afternoon (p<0.05). Late bedtime was observed in all groups: without carbohydrate metabolism disorders 22.50–00.29h, with prediabetes 22.30–00.29h and T2DM 22.45–00.29h with an increase in sleep duration in the prediabetes group (08.14h, 09.00h and 08.38h, respectively). In all groups, morning and evening chronotypes had correlations with the amplitude of the daily rhythm of glycemia (r=-0.7, p=0.002 and r=-0.6, p=0.035), basal body temperature (r=0.4, p=0.046 and r=-0.5, p<0.0001) and daily energy value (r=-0.6, p= 0.041 and r=-0.6, p=0.05), differing only in the strength of the relationship.CONCLUSION: Thus, people with the morning and intermediate types of the morning chronotype, who organize a daily routine and nutrition that do not correspond to the individual characteristics of this given chronotype, can, along with people of the evening chronotype, become vulnerable in the context of the development of type 2 diabetes.
背景:在医学文献来源中,有关于昼夜节律紊乱(不同步)与2型糖尿病(T2DM)发展关系的数据。血糖昼夜节律的不同步可以由外部因素(晚上暴露于过多的人工照明,违反饮食,“睡眠-觉醒”)和内部因素(来自昼夜节律的个体组织(时间类型))触发。在这方面,有兴趣对昼夜节律组织的个体特征对发展为2型糖尿病风险的影响进行最详细的研究。目的:探讨无碳水化合物代谢障碍、糖尿病前期和2型糖尿病合并肥胖、BMI = 30.0-34.9 kg/m2的个体昼夜节律组织特征。材料和方法:Тhe霍恩-奥斯特伯格问卷回顾性分析无碳水化合物代谢紊乱的内脏型肥胖(n=40)、前驱糖尿病(n=40)和T2DM (n=40)患者。将Horn-Ostberg试验结果与健忘性人体测量、实验室参数、营养日记、碳水化合物和能量代谢综合生理指标的日节律进行比较。结果:所有研究参与者(n=120)年龄相同,56,7 [52,2;58,6]岁,BMI 31.3 [30.7;33.9] kg/m2,女性腰围(OW) 96.54±1.35 cm,男性98.75±2.61 cm。性别分布:女性73%,男性27%。早起型的人占24%(29人),中间型占63%(75人),晚睡型占13%(16人)。在各组中,第一顿早餐的时间较晚(无碳水化合物代谢紊乱者9:45h,糖尿病前期者9:31 h, T2DM患者10:00h), 20%的参与者错过了这一时间(p<0.05)。日能值向下午偏移量较大(p<0.05)。所有组均出现晚睡现象:无碳水化合物代谢紊乱22.50 - 00.29小时,糖尿病前期22.30 - 00.29小时,T2DM 22.45 - 00.29小时,糖尿病前期组睡眠时间增加(分别为08.14小时、09.00小时和08.38小时)。在所有组中,早晚时间型与每日血糖节律的幅度(r=-0.7, p=0.002和r=-0.6, p=0.035)、基础体温(r=0.4, p=0.046和r=-0.5, p<0.0001)和每日能量值(r=-0.6, p= 0.041和r=-0.6, p=0.05)相关,差异仅在于关系的强度。结论:因此,具有早晨和中间类型的早晨时间型的人,他们的日常生活和营养安排与该给定时间型的个体特征不相符,可能与晚上时间型的人一样,在2型糖尿病的发展背景下变得脆弱。
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引用次数: 0
Diabetes mellitus associated with type A insulin resistance 糖尿病与A型胰岛素抵抗相关
Pub Date : 2023-07-14 DOI: 10.14341/dm13011
E. Sechko, T. Kuraeva, V. Peterkova, D. Laptev
Insulin resistance type A is a monogenic disorder with insulin action defect, observed in females with acanthosis nigricans (AN), hyperandrogenism, hyperinsulinemia, insulin resistance (IR) without obesity. We present a family case of diabetes mellitus (DM) with IR in two sisters with obesity and positive family history of DM in three generations. Hyperglycemia was identified at the age of 13 in the older sister and at 11 in the younger sister after COVID-19. Type 2 diabetes (DM2) was diagnosed in mother in the same time with children. Maternal grandmother was diagnosed with DM2 in 58 years old. Patients were examined in 6 months after diagnosis hyperglycemia in Endocrinology Research Centre. The older sister had obesity, AN, and striae distensae. Glycosylated hemoglobin (HbA1c) 6.2%. Impaired glucose tolerance (IGT), hyperinsulinemia and IR, hyperandrogenism, non-alcoholic fatty liver disease (NAFLD), arterial hypertension were diagnosed. The younger sister had obesity, striae distensae. HbA1c — 6.0%. Impaired fasting glucose (IFG), IGT, hyperinsulinemia, IR, NAFLD were diagnosed. Antibodies (AAb) to ZnT8A, IA2, GAD absented in both sisters. A genetic test was provided, a heterozygous mutation in the INSR gene p.V167M was identified in both sisters, mother and grandmother. IR type A was identified in a family with the phenotype of DM2 in this case. This case demonstrated that children with carbohydrate metabolism disorders and obesity without Islet cell autoantibodies have to reffered for a genetic testing. Disordered carbohydrate metabolism was diagnosed in the same time after a COVID-19 in three family members who did not previously have disordered carbohydrate metabolism. We suppose that SARS-CoV-2 can be a trigger for the development of carbohydrate metabolism disorders in IR type A.
胰岛素抵抗A型是一种具有胰岛素作用缺陷的单基因疾病,见于无肥胖的黑棘皮病(AN)、高雄激素症、高胰岛素血症、胰岛素抵抗(IR)的女性。我们报告一例糖尿病(DM)合并IR的家族病例,两姐妹均为肥胖,且三代都有糖尿病家族史。在COVID-19后,姐姐在13岁时被发现高血糖,妹妹在11岁时被发现高血糖。2型糖尿病(DM2)的母亲与孩子同时被诊断。外祖母在58岁时被诊断为DM2。患者于诊断为高血糖后6个月在内分泌研究中心接受检查。姐姐有肥胖、AN和扩张纹。糖化血红蛋白(HbA1c) 6.2%诊断为糖耐量受损(IGT),高胰岛素血症和IR,高雄激素症,非酒精性脂肪性肝病(NAFLD),动脉高血压。妹妹肥胖,有张纹。HbA1c - 6.0%。诊断为空腹血糖(IFG)、IGT、高胰岛素血症、IR、NAFLD。两姐妹均无ZnT8A、IA2、GAD抗体(AAb)。通过基因检测,在姐妹、母亲和祖母中发现了INSR基因p.V167M的杂合突变。在本病例中,在一个具有DM2表型的家族中鉴定出IR A型。本病例表明,患有碳水化合物代谢紊乱和肥胖的儿童没有胰岛细胞自身抗体,必须进行基因检测。在三个以前没有碳水化合物代谢紊乱的家庭成员感染COVID-19后,同时诊断出碳水化合物代谢紊乱。我们认为SARS-CoV-2可能是IR a型患者碳水化合物代谢紊乱的触发因素。
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引用次数: 0
Islet autoantibodies and residual beta-cell function in children with type 1 diabetes depending on age of manifestation 1型糖尿病儿童胰岛自身抗体和残余β细胞功能与表现年龄的关系
Pub Date : 2023-07-14 DOI: 10.14341/dm12955
E. Romanenkova, I. M. Zufarova, D. Y. Sorokin, I. Eremina, E. Sechko, L. Nikankina, V. Peterkova, O. Bezlepkina, D. Laptev
BACKGROUND: Type 1 diabetes mellitus (T1D) is an autoimmune disorder that leads to pancreatic β-cells destruction and progressive decrease of insulin secretion. Specific islet autoantibodies (AAbs) are the main diagnostic marker of T1D. Residual β-cell function, as measured by C-peptide, has repeatedly been demonstrated to be clinically important.AIM: To study the frequency and levels of residual C-peptide secretion and persistence of pancreatic AAbs in children with T1D with different duration and age of manifestation of the disease.MATERIALS AND METHODS: The levels of C-peptide and AAbs to ZnT8 (zinc transporter 8), AAbs to IA-2 (Insulinoma Antigen 2), AAbs to GAD (Glutamate Decarboxylase), IAA (insulin autoantibodies) were measured. Patients were divided into 3 groups depending on the duration of T1D (1st — <1 year, 2nd — from 1 to 5 years, 3rd — >5 years) and age of manifestation (A — prepubertal and B — puberty).RESULTS: The median duration of T1D was 1.8 [0,8;3,9], 76.3% out of 1333 patients were seropositive, 40% had residual levels of C-peptide. With disease duration there were a decrease in AAbs+: 1st group 74%, 2nd group 69%, and 3rd group 48%. In all groups, percentage of patients with positive levels of one or more AAbs was significantly higher in children with T1D manifestation at puberty. GADA and ZnT8A were more common in the first year of the disease. IA-2A were observed with the same frequency in the group of adolescents. IAA were more common in patients at prepubertal age. An undetectable level of C-peptide was observed significantly higher in children with T1D manifestation in prepubertal age (p<0.05): 1А — 13% and 1B — 5%, 2А — 51% and 2B — 14%, 3А — 82% and 3B — 50%, reference range of C-peptide was observed in adolescents (p<0,05): 1А — 6% and 1B — 44%, 2А — 2% and 2b — 25%, 3А — 2% and 3B — 11%.CONCLUSION: AAbs+ is relatively common in children with T1D and about half of them are seropositive in more than 5 years after manifestation. GADA and ZnT8A have high specificity for patients with new-onset T1D. C-peptide secretion depends on the age of the disease manifestation.
背景:1型糖尿病(T1D)是一种自身免疫性疾病,导致胰腺β细胞破坏和胰岛素分泌进行性减少。特异性胰岛自身抗体(AAbs)是T1D的主要诊断标志物。残余β细胞功能,如c肽测量,已多次被证明是重要的临床。目的:研究T1D患儿不同病程和发病年龄胰腺中残余c肽分泌的频率、水平及胰腺自身抗体的持久性。材料与方法:测定c肽、ZnT8(锌转运蛋白8)抗体、IA-2(胰岛素瘤抗原2)抗体、GAD(谷氨酸脱羧酶)抗体、IAA(胰岛素自身抗体)抗体水平。根据T1D病程(1 - 5年)和表现年龄(A -青春期前和B -青春期)将患者分为3组。结果:T1D的中位持续时间为1.8[0,8;3,9],1333例患者中76.3%血清阳性,40% c肽残留水平。随着病程的延长,抗体阳性水平下降:第一组74%,第二组69%,第三组48%。在所有组中,青春期表现为T1D的儿童中,一种或多种自身抗体阳性水平的患者百分比明显更高。GADA和ZnT8A在发病第一年更为常见。IA-2A在青少年组中出现的频率相同。IAA多见于青春期前。未检出的c肽水平在青春期前表现为T1D的儿童中较高(p<0.05): 1А - 13%和1B - 5%, 2А - 51%和2B - 14%, 3А - 82%和3B - 50%,青少年c肽水平参考范围(p<0.05): 1А - 6%和1B - 44%, 2А - 2%和2B - 25%, 3А - 2%和3B - 11%。结论:抗体+在T1D患儿中较为常见,约半数患儿在发病后5年以上仍呈血清阳性。GADA和ZnT8A对新发T1D患者具有较高的特异性。c肽的分泌取决于疾病表现的年龄。
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引用次数: 0
Results of a 12-month follow-up of patients with type 2 diabetes mellitus after hospitalization with COVID-19: gliclazide MR use in the hospital and metabolic status at the posthospital stage 2型糖尿病患者新冠肺炎住院后12个月随访结果:院内格列齐特MR使用情况及院后代谢状况
Pub Date : 2023-07-14 DOI: 10.14341/dm13003
T. A. Nekrasova, L. Strongin, D. V. Belikina, E. S. Malysheva, A. A. Nekrasov
BACKGROUND: The role of antidiabetic drugs in inpatient with COVID-19 and type 2 diabetes mellitus (T2DM) is usually considered in the context of target glycemiа maintaining. Except for insulin therapy sulfonylurea may be used in moderate COVID-19. The use of original gliclazide MR has advantages due to low risk of hypoglycemia and established cardio- and nephroprotective effects. But it is not clear whether the choice of antidiabetic drugs during hospitalization may affect patient’s condition in post-COVID period.AIM:. To assess the 12-month dynamics of carbohydrate metabolism in patients with T2DM after hospitalization for COVID-19 considering the character of hypoglycemic therapy in the hospital and the use of gliclazide MRMATERIALS AND METHODS: A 12-month prospective study was performed; T2DM patients were observed after hospitalization for COVID-19. They received in hospital: 1) original gliclazide MR (Diabeton MR, n=20) and 2) insulin (control group, n=20). Changes in antidiabetic therapy, glycemic control and biochemical tests were assessed at baseline and after 3, 6, 12 months. RESULTS: In the main and control groups the intensification of T2DM therapy was observed: the proportion of patients without hypoglycemic drugs decreased within a year by 3.0 (p = 0.001) and 2.8 (p =0.010) times respectively. Mean HbA1c values,the dynamics of inflammation markers and transaminases in both groups were similar (p>0.05 at all visits). Blood creatinine was at baseline 82.9±18.67 and 120.9±45.52 µmol/l (p=0.010), after 3 months — 88.0±18.77 and 104, 5±17.99 µmol/l (p=0.024), after 6 months — 89.3±12.17 and 97.5±9.03 µmol/l (p=0.072), after 12 months — 86.7±10.50 and 93.9±16.76 µmol/l (p=0.16). According to the data obtained during «3 months» visit, the dose of original gliclazide MR was directly correlated with the improvement in renal function in terms of glomerular filtration rateGFR (R=0,59, р=0,010). In addition, there was a close-to-significance correlation between continued gliclazide MR at visit 3 and improvement in GFR at visit 6 (R=0.31, p=0.076).CONCLUSION: The post-hospital period in patients with COVID-19 and T2DM was characterized by a tendency to hyperglycemia and increased need for hypoglycemic therapy. The use of original gliclazide MR by in patients with moderate COVID-19 and T2DM is appropriate and safe in terms of clinical and metabolic parameters dynamics during long-term post-hospital follow-up. When original gliclazide MR is continued during the post-hospital period its nephroprotective properties may contribute to the process of renal functions normalization which should be confirmed by further research.
背景:降糖药物在COVID-19合并2型糖尿病(T2DM)住院患者中的作用通常被认为是在维持目标血糖水平的背景下进行的。除胰岛素治疗外,磺脲类药物可用于中度COVID-19。使用原始格列齐特MR具有低低血糖风险和已建立的心脏和肾脏保护作用的优势。但目前尚不清楚住院期间降糖药物的选择是否会影响患者后疫情时期的病情。考虑到医院降糖治疗的特点和格列齐特mr的使用,评估T2DM患者因COVID-19住院后12个月的碳水化合物代谢动态。材料和方法:进行了一项12个月的前瞻性研究;T2DM患者在COVID-19住院后进行观察。在医院接受:1)原始格列齐特MR(糖尿病MR, n=20)和2)胰岛素MR(对照组,n=20)。在基线和3、6、12个月后评估抗糖尿病治疗、血糖控制和生化试验的变化。结果:试验组和对照组T2DM治疗强化,1年内未使用降糖药的患者比例分别下降3.0倍(p = 0.001)和2.8倍(p =0.010)。两组患者的平均HbA1c值、炎症标志物和转氨酶动态相似(p>0.05)。血肌酐基线分别为82.9±18.67和120.9±45.52µmol/l (p=0.010), 3个月后分别为88.0±18.77和104,5±17.99µmol/l (p=0.024), 6个月后分别为89.3±12.17和97.5±9.03µmol/l (p=0.072), 12个月后分别为86.7±10.50和93.9±16.76µmol/l (p=0.16)。根据“3个月”随访期间获得的数据,就肾小球滤过率而言,原始格列昔特MR剂量与肾功能改善直接相关(R=0,59, R= 0,010)。此外,第3次随访时持续格列齐特MR与第6次随访时GFR改善之间存在接近显著的相关性(R=0.31, p=0.076)。结论:COVID-19合并T2DM患者院后阶段具有高血糖倾向和降糖治疗需求增加的特点。从临床和长期院后随访的代谢参数动态来看,中度COVID-19合并T2DM患者使用原始格列齐特MR是适当和安全的。当原格列齐特MR在出院后继续使用时,其肾保护作用可能有助于肾功能的正常化过程,有待进一步研究证实。
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引用次数: 0
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Journal of diabetes mellitus
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